Thyroidectomy under local anaesthesia in a poor resource health facility in Northeastern Nigeria

Abstract

Background:The provision of quality health care is one of the priorities of every government. The quality of such care is however, limited by the human and technical resources available. The varying types of thyroidectomy for Goitres are often done under general anaesthesia, unless, there is a contraindication such as, cardiopulmonary instability. Recently, there is increasing evidence that thyroidectomy could be done under local anaesthesia with or without anxiolytics or opioid analgesia augmentation. This study reports on our experience of performing thyroidectomy under infi ltrative local anaesthesia.Objectives: To evaluate the safety of performing thyroidectomy under infi ltrative local anaesthesia and compare the post-operative outcome with that done under general anaesthesia.Patients and methods: This is a descriptive case series of 59 patients that underwent thyroidectomy under fi eld block with 1% Lignocaine with Adrenaline 1:200,0000 dilutions. Dose was standardised for all patients at 4mg/kg under monitored anaesthesia. The period under study covered from October 2017-October 2019. The patients' characteristics analysed were Biodata, clinical diagnosis, patients' weight, type of surgery, duration of surgery and complications. Results:The study population were 59 patients, 88.1% were females, 11.9% were males with female -male ratio of 8:1. The mean age was 42.03(+_3.5), simple multinodular goitre was the most common subtype 47.5%, toxic multinodular goitre 39%, diffuse simple goitre and diffuse toxic goitre 5.1% each. Malignant goitre 3.4% and all are papillary carcinomas. 54,2% off all the goitres are WHO grade 3. The mean duration of surgery is 40minutes and the average duration of hospital stay is 24-48hours. There were 6 complications. 1(1.7%) sub-cutaneous haematoma, 1(1.7%) post-operative hypocalcaemia, 2(3.4%) keloidal scar and 2(3.4%) surgical site infections. Conclusion:Thyroidectomy under infi ltrative local anaesthesia is safe if done by a trained surgeon, in a poor resource health facility.Limitation: Patient's preference for general anaesthesia and short-necked, obese patients.

Thyroidectomy under Local Anaesthesia: A Viable Option in a Resource Limited Community

“…This is similar to what was reported by other authors [9] [12] [13] [15] [17]. In a study conducted in Potiskum, Nigeria, the authors reported a mean duration of surgery of 40 minutes [16], much lower than what was observed in this study. But because most of these studies did not clearly define the period they consider as the duration of surgery, it is difficult to compare their findings.…”

“…Ahmad and colleagues reported a female preponderance (22 females, and 8 males) in a cross sectional study of thyroid surgery under LA [13]. Similar findings of female preponderance among patients that had thyroidectomy under LA were also reported by other authors [14] [15] [16]. Eke et al did not report any male patient among the 15 patients with giant goiters who had thyroidectomies under LA in their study [9].…”

“…Bilateral thyroidectomy and total thyroidectomy are generally the least common types of thyroidectomies done under LA by surgeons as compared with lobectomies [12] [13] [15] [16]. Aliyu and colleagues in a descriptive study of thyroidectomy under LA in a poor resource setting in Northeastern Nigeria reported subtotal thyroidectomy among 49.2% of their patients, near total thyroidectomy among 47.5% of their patients and total thyroidectomy among only 3.4% of their patients [16]. A cross sectional study on thyroid surgery under LA in Bangladesh among 30 patients reported hemi-thyroidectomy among 16 (53.3%) patients, subtotal thyroidectomy among 8 (26.7%) patients and total thyroidectomy among 6 (20%) patients.…”

Euthyroidectomy under local versus general anesthesia in health camp settings in Uganda: a protocol for randomized prospective equivalence single-blind controlled trial

“…Henceforth due to drawbacks of GA, in the last two decades, there has been an increase in the number of thyroidectomies performed under regional/LA combined with monitored anesthesia care [ 11 , 13 ]. These numbers have even increased further with the development of minimally invasive thyroidectomy particularly in short-stay settings [ 9 ] and now, a few surgeons in the western world are currently doing thyroidectomies exclusively under LA [ 8 ].…”

“…Other than overcoming the need to book for intensive care space and an anesthesiologist [ 14 ], which most patients in low-income countries cannot afford in the case of thyroidectomy under GA [ 15 ], LA has been associated with less post-operative pain, costs, hospital stay duration, post-operative nausea, vomiting, throat discomfort, and voice changes [ 9 , 16 , 17 ]. According to research in Nigeria [ 13 ], India [ 8 ], and USA [ 16 ], complications such as hematoma, surgical site infection, and colloid occur in less than 4% of cases of thyroidectomy performed under LA. In a randomized controlled study in Germany [ 9 ], the occurrences of post-operative complications (pain, nausea, vomiting, throat discomfort, painful swallowing, voice change, and difficulty in breathing were less in the group of patients who underwent thyroidectomy under LA as compared with those under GA in contrast to the prospective study in Uganda [ 18 ].…”